Chuck Durbin was one of those patients who always was appreciative of the care he received from his doctors. (Though his warm acceptance of others extended not only to those that he knew, but to strangers as well.) Consequently every encounter with him felt nonthreatening even if all you had to give him was bad news. As a result he made me feel good about myself and confident I was doing the best possible job I could for him.
Chuck was 63 years of age and had been diagnosed with prostate cancer. Unfortunately cancer was not unfamiliar to him as his father had died from lung cancer and his mother, from colon cancer.
Three years ago during the course of a routine blood work, Chuck was found to have an elevated PSA, or prostate specific antigen. This is a very sensitive indicator of prostate cancer. In many cases when prostate cancer is first diagnosed, it is confined to the prostate and men have a number of treatment options available in an effort to eradicate and cure the cancer before it spreads.
Sadly, this was not the case for Chuck. His biopsy indicated extensive infiltration of the cancer and a further workup indicated the cancer had already metastasized to his bones. In fact he had soon developed metastatic cancer to his spine, pelvis and the femur bones in his legs. Yet Chuck kept upbeat and was determined to fight his cancer no matter what the odds.
Because the metastatic cancer in his spine was particularly painful Chuck underwent radiation treatments. He also received chemotherapy but because his cancer seemed to be refractory to the drugs he received he participated in several experimental protocols both here in Florida and in New York. But in spite of the efforts of all of his doctors and Chuck’s dogged perseverance, his cancer never went into remission.
And if that was not enough, as a result of the treatments he received, his bone marrow was damaged to the point that it would not produce the normal amount of blood cells necessary for everyday life. This meant that with a low red blood cell count he would feel tired; with a low white blood cell count he was at risk for infection and with a low platelet count he could spontaneously hemorrhage anywhere in his body.
It was because of this last problem that I came to know and become involved with Chuck Durbin’s care.
In receiving his chemotherapy, Chuck would occasionally experience nausea and even vomiting, but usually with some medication these symptoms would pass. This time they did not and because he also had developed a headache, a brain scan was ordered by his oncologist. The CT revealed a subdural hematoma, or a blood clot on the surface of his brain and so he was admitted to Mease Hospital.
Fortunately, surgery wasn’t immediately necessary.
When I walked into Chuck’s room in the ICU for the first time and introduced myself, he made me feel as though I had known him for ten years. In spite of his terminal condition he welcomed me as he would the rest of his family, who surrounded his bed. I reviewed the findings on the CT scan with him and told him that for the time being we would not have to consider surgery. As his headache had subsided with intravenous administration of dexamethasone he was grateful I wouldn’t have to drill any holes in his skull.
I followed Chuck for that week he was hospitalized, stopping by to see him on a daily basis even though there wasn’t much I could do. Despite the numerous transfusions which he received his platelet count remained low, too low to even consider surgery. In addition, because of the persistent low platelet count, there was a constant risk of further hemorrhage.
Although I would later discover surgery wasn’t something Chuck was willing to consider in any event.
Though he fought a long hard battle, he had come to the realization that the end was likely near. Not surprisingly, he did not become depressed… actually quite the opposite. He did however, make his wishes known to his wife Claire and their children. If the ‘time’ came he did not want any extraordinary measures and he definitely did not want to be resuscitated should his heart stop beating.
Over the years of performing neurosurgery, I have not always been successful, but my training has nonetheless conditioned my inherent being to want to save patients from death. I cannot always know what the outcome will be, so in most cases I do what I can and leave the rest in God’s hands. I have to admit this has not always appeared to have been the best approach. Often time’s, patients die anyway and the family rides a roller coaster of emotion having hope, then becoming distraught followed by the inevitable grief of the loss of their loved one.
Sometimes however it does give the family the opportunity to come to accept what has happened because things happened so quickly. Families would tell me, ‘We can’t believe it…just last week mom was fine without any complaints and even had gone bowling like she did every Monday afternoon’ and now, ‘without warning she is lying in a hospital bed in a coma’!
With Chuck, however, he, Claire and all his family were well aware of the terminal nature of his disease and knew this day would eventually come. Though they hoped it wouldn’t be so soon; in a way, they were ready.
So they all sat by Chuck’s side every day, every night, just talking and enjoying his company whenever his headache would permit. And though he had been comfortable for the first few days his headache seemed to be getting worse.
On Saturday I was making rounds in the Intensive Care Unit and Chuck’s nurse, Barbara came up to me and told me that he had become less responsive. One look at him from my seat across the hall told me all I had to know. His breathing had become labored and I knew this likely was the end.
I told Barbara to get a CT of the head, stat, and I asked for Claire’s cell phone number. I called her and told her of Chuck’s condition. She told me that she was on her way.
As soon as she got to the ICU the CT was completed. I reviewed the scan with her and showed her where there had been more bleeding in the brain and that the subdural hematoma had increased significantly in size. ‘Now’ I told her, ‘there was pressure on the vital areas of the brain stem controlling Chuck’s breathing and his heart’. She nodded in agreement… and acceptance.
I told her I would do whatever she wished, although surgery in Chuck’s case would be extremely risky and would probably not alter the events of what were now transpiring. She said, ‘No, he knew this was coming and he was ready’.
I went outside the room to the sitting area where the hospital charts were kept to write my progress note. Claire came out briefly to ask me, ‘Is he in any pain?’ Instinctively my military background took over as I looked up and said, ‘No, Mam’. She looked at me somewhat embarrassingly and said, ‘Please, call me Claire, and thank you for all you have done’ as she turned and walked back in to be at Chuck’s side.
